For a Sick Friend: First, Do No Harm. By Letty Cottin Pogrebin
Conversing with the ill can be awkward, but keeping a few simple commandments makes a huge difference
The Wall Street Journal, April 13, 2013, on page C3
http://online.wsj.com/article/SB10001424127887324240804578416574019136696.html
'A closed mouth gathers no feet." It's a charming axiom, but silence isn't always an option when we're dealing with a friend who's sick or in despair. The natural human reaction is to feel awkward and upset in the face of illness, but unless we control those feelings and come up with an appropriate response, there's a good chance that we'll blurt out some cringe-worthy cliché, craven remark or blunt question that, in retrospect, we'll regret.
Take this real-life exchange. If ever the tone deaf needed a poster child, Fred is their man.
"How'd it go?" he asked his friend, Pete, who'd just had cancer surgery.
"Great!" said Pete. "They got it all."
"Really?" said Fred. "How do they know?"
A few simple commandments makes a huge difference when conversing with the ill.
Later, when Pete told him how demoralizing his remark had been, Fred's excuse was, "I was nervous. I just said what popped into my head."
We're all nervous around illness and mortality, but whatever pops into our heads should not necessarily plop out of our mouths. Yet, in my own experience as a breast-cancer patient, and for many of the people I have interviewed, friends do make hurtful remarks. Marion Fontana, who was diagnosed with breast cancer eight years after her husband, a New York City firefighter, died in the collapse of the World Trade Center, was told that she must have really bad karma to attract so much bad luck. In another case, upon hearing a man's leukemia diagnosis, his friend shrieked, "Wow! A girl in my office just died of that!"
You can't make this stuff up.
If we're not unwittingly insulting our sick friends, we're spouting clichés like "Everything happens for a reason." Though our intent is to comfort the patient, we also say such things to comfort ourselves and tamp down our own feelings of vulnerability. From now on, rather than sound like a Hallmark card, you might want to heed the following 10 Commandments for Conversing With a Sick Friend.
1. Rejoice at their good news. Don't minimize their bad news. A guy tells you that the doctors got it all, say "Hallelujah!" A man with advanced bladder cancer says that he's taking his kids to Disneyland next summer, don't bite your lip and mutter, "We'll see." Tell him it's a great idea. (What harm can it do?) Which doesn't mean that you should slap a happy face on a friend's grim diagnosis by saying something like, "Don't worry! Nowadays breast cancer is like having a cold!"
The best response in any encounter with a sick friend is to say, "Tell me what I can do to make things easier for you—I really want to help."
2. Treat your sick friends as you always did—but never forget their changed circumstance. However contradictory that may sound, I promise you can learn to live within the paradox if you keep your friend's illness and its constraints in mind but don't treat them as if their illness is who they are. Speak to them as you always did (tease them, kid around with them, get mad at them) but indulge their occasional blue moods or hissy-fits. Most important, start conversations about other things (sports, politics, food, movies) as soon as possible and you'll help speed their journey from the morass of illness to the miracle of the ordinary.
3. Avoid self-referential comments. A friend with a hacking cough doesn't need to hear, "You think that's bad? I had double pneumonia." Don't tell someone with brain cancer that you know how painful it must be because you get migraines. Don't complain about your colicky baby to the mother of a child with spina bifida. I'm not saying sick people have lost their capacity to empathize with others, just that solipsism is unhelpful and rude. The truest thing you can say to a sick or suffering friend is, "I can only try to imagine what you're going through."
4. Don't assume, verify. Several friends of Michele, a Canadian writer, reacted to her cancer diagnosis with, "Well, at least you caught it early, so you'll be all right!" In fact, she did not catch it early, and never said or hinted otherwise. So when someone said, "You caught it early," she thought, "No, I didn't, therefore I'm going to die." Repeat after me: "Assume nothing."
5. Get the facts straight before you open your mouth.Did your friend have a heart or liver transplant? Chemo or radiation? Don't just ask, "How are you?" Ask questions specific to your friend's health. "How's your rotator cuff these days?" "Did the blood test show Lyme disease?" "Are your new meds working?" If you need help remembering who has shingles and who has lupus, or the date of a friend's operation, enter a health note under the person's name in your contacts list or stick a Post-it by the phone and update the information as needed.
6. Help your sick friend feel useful. Zero in on one of their skills and lead to it. Assuming they're up to the task, ask a cybersmart patient to set up a Web page for you; ask a bridge or chess maven to give you pointers on the game; ask a retired teacher to guide your teenager through the college application process. In most cases, your request won't be seen as an imposition but a vote of confidence in your friend's talent and worth.
7. Don't infantilize the patient. Never speak to a grown-up the way you'd talk to a child. Objectionable sentences include, "How are we today, dearie?" "That's a good boy." "I bet you could swallow this teeny-tiny pill if you really tried." And the most wince-worthy, "Are we ready to go wee-wee?" Protect your friend's dignity at all costs.
8. Think twice before giving advice.Don't forward medical alerts, newspaper clippings or your Aunt Sadie's cure for gout. Your idea of a health bulletin that's useful or revelatory may mislead, upset, confuse or agitate your friend. Sick people have doctors to tell them what to do. Your job is simply to be their friend.
9. Let patients who are terminally ill set the conversational agenda.If they're unaware that they're dying, don't be the one to tell them. If they know they're at the end of life and want to talk about it, don't contradict or interrupt them; let them vent or weep or curse the Fates. Hand them a tissue and cry with them. If they want to confide their last wish, or trust you with a long-kept secret, thank them for the honor and listen hard. Someday you'll want to remember every word they say.
10. Don't pressure them to practice 'positive thinking.' The implication is that they caused their illness in the first place by negative thinking—by feeling discouraged, depressed or not having the "right attitude." Positive thinking can't cure Huntington's disease, ALS or inoperable brain cancer. Telling a terminal patient to keep up the fight isn't just futile, it's cruel. Insisting that they see the glass as half full may deny them the truth of what they know and the chance to tie up life's loose ends while there's still time. As one hospice patient put it, "All I want from my friends right now is the freedom to sulk and say goodbye."
Though most of us feel dis-eased around disease, colloquial English proffers a sparse vocabulary for the expression of embarrassment, fear, anxiety, grief or sorrow. These 10 commandments should help you relate to your sick friends with greater empathy, warmth and grace.
—Ms. Pogrebin is the author of 10 books and a founding editor of Ms. magazine. Her latest book is "How to Be a Friend to a Friend Who's Sick," from which this essay is adapted.
The crisis is Cyprus is still unfolding and the
final resolution might still have some way to go, but the events in
Nicosia and Brussels already offer some first lessons. And these lessons
look certainly familiar to those who have studied previous crises.
Bets are that Cyprus will not be the Troika’s last patient, with one
South European finance minister already dreading the moment where he might be in a situation like his Cypriot colleague.
Even more important, thus to analyze the on-going Cyprus crisis
resolution for insights into where the resolution of the Eurozone crisis
might be headed and what needs to be done.
1. A deposit insurance scheme is only as good as the sovereign backing it
One of the main objectives of deposit insurance is to prevent bank
runs. That was also the idea behind the increase of deposit insurance
limits across the Eurozone to 100,000 Euro after the Global Financial
Crisis. However, deposit insurance is typically designed for
idiosyncratic bank failures, not for systemic crises. In the latter
case, it is important that public back stop funding is available.
Obviously, the credibility of the latter depends on a solvent sovereign.
As Cyprus has shown, if the solvency of the sovereign is itself in
question, this will undermine the confidence of depositors in a deposit
insurance scheme. In the case of Cyprus, this confidence has been
further undermined by the initial idea of imposing a tax on insured
deposits, effectively an insurance co-payment, contradicting maybe not
in legal terms but definitely in spirit the promise of deposit insurance
of up to 100,000 Euros. The confidence that has been destroyed with the
protracted resolution process and the back-and-forth over loss
distribution will be hard to re-establish. A banking system without the
necessary trust, in turn, will be hard pressed to fulfill its basic
functions of facilitating payment services and intermediating savings.
Ultimately, this lack of confidence can only be overcome by a Eurozone
wide deposit insurance scheme with public back-stop funding by ESM and a
regulatory and supervisory framework that depositors can trust.
2. A large financial system is not necessarily growth enhancing
An extensive literature has documented the positive relationship
between financial deepening and economic growth, even though the recent
crisis has shed doubts on this relationship (Levine, 2005, Beck, 2012).
However, both theoretical and empirical literature focus on the
intermediation function of the financial system, not on the size of the
financial system per se. Very different from this financial facilitator view is the financial center view, which
sees the financial sector as an export sector, i.e. one that seeks to
build a nationally centered financial center stronghold based on
relative comparative advantages such as skill base, favorable regulatory
and tax policies, (financial safety net) subsidies, etc. Economic
benefits of such a financial center might also include important
spin-offs coming from professional services (legal, accounting,
consulting, etc.) that tend to cluster around the financial sector.
In recent work with Hans Degryse and Christiane Kneer (2013) and
using pre-2007 data, we have shown that a large financial system might
stimulate growth in the short-term, but comes at the expense of higher
volatility. It is the financial intermediation function of finance that
helps improve growth prospects not a large financial center, a lesson
that Cyprus could have learned from Iceland.
3. Crisis resolution as political distribution fight
Resolution processes are basically distributional fights about who
has to bear losses. The week-long negotiations about loss allocation
in Cyprus are telling in this respect. While it was initially Eurozone
authorities that were blamed for imposing losses on insured depositors,
there is an increasingly clear picture that it was maybe the Cypriot
government itself that pushed for such a solution in order to avoid
imposing losses on large, (and thus most likely) richer and more
connected depositors.
While the Cypriot case might be the most egregious recent example for
the entanglement of politics and crisis resolution, the recent crises
offer ample examples of how politically sensitive the financial system
is. Just two more examples here: First, even during and after the
Global Financial Crisis of 2008 and 2009, there was still open political
pressure across Europe to maintain or build up national champions in
the respective banking systems, even at the risk of creating more
too-big-to-fail banks. Second, the push by the German government to
exempt German small savings and cooperative banks from ECB supervision
and thus the banking union can be explained only on political basis and
not with economic terms, as the "too-many-to-fail" is as serious as the
"too-big-to-fail" problem.
4. Plus ca change, plus c'est la meme chose
European authorities and many observers have pointed to the special
character of each of the patients of the Eurozone crisis and their
special circumstances. Ireland and Spain suffered from housing booms and
subsequent busts, Portugal from high current account deficits stemming
from lack of competitiveness and mis-allocation of capital inflows,
Greece from high government deficit and debt and now Cyprus from an
oversized banking system. So, seemingly different causes, which call for
different solutions!
But there is one common thread across all crisis countries, and that
is the close ties between government and bank solvency. In the case of
Ireland, this tie was established when the ECB pushed the Irish
authorities to assume the liabilities of several failed Irish banks. In
the case of Greece, it was the other way around, with Greek banks having
to be recapitalized once sovereign debt was restructured. In all
crisis countries, this link is deepened as their economies go into
recession, worsening government’s fiscal balance, thus increasing
sovereign risk, which in turn puts balance sheets of banks under
pressure that hold these bonds but also depend on the same government
for possible recapitalization. This tie is exacerbated by the tendency
of banks to invest heavily in their home country’s sovereign bonds, a
tendency even stronger in the Eurozone’s periphery (Acharya, Drechsler and Schnabl, 2012).
Zero capital requirements for government bond holdings under the Basel
regime, based on the illusion that such bonds in OECD countries are safe
from default, have not helped either.
5. If you kick the can down the road, you will run out of road eventually
The multiple rounds of support packages for Greece by Troika, built
on assumptions and data, often outdated by the time agreements were
signed, has clearly shown that you can delay the day of reckoning only
so long. By kicking the can down the road, however, you risk
deteriorating the situation even further. In the case of Greece that led
eventually to restructuring of sovereign debt. Delaying crisis
resolution of Cyprus for months if not years has most likely also
increased losses in the banking system. A lesson familiar from many
emerging market crises (World Bank. 2001)!
On a first look, the Troika seemed eager to avoid this mistake in the
case of Cyprus, forcing recognition and allocation of losses in the
banking system early on without overburdening the sovereign debt
position. However, the recession if not depression that is sure to
follow in the next few years in Cyprus will certainly increase the
already high debt-to-GDP ratio and might ultimately lead to the need for
sovereign debt restructuring.
6. The Eurozone crisis — a tragedy of commons
The protracted resolution process of Cyprus has shown yet again, that
in addition to a banking, sovereign, macroeconomic and currency crisis,
the Eurozone faces a governance crisis. Decisions are taken jointly by
national authorities who each represent the interest of their respective
country (and taxpayers), without taking into account the externalities
of national decisions arising on the Eurozone level. It is in the
interest of every member government with fragile banks to "share the
burden" with the other members, be it through the ECB’s liquidity
support or the Target 2 payment system. Rather than coming up with
crisis resolution on the political level, the ECB and the Eurosystem are
being used to apply short-term (liquidity) palliatives that deepen
distributional problems and make the crisis resolution more difficult.
What is ultimately missing is a democratically legitimized authority
that represents Eurozone interests.
7. Learning from the Vikings
In 2008, Iceland took a very different approach from the Eurozone
when faced with the failure of their oversized banking system. It
allowed its banks to fail, transferred domestic deposits into good banks
and left foreign deposits and other claims and bad assets in the
original banks, to be resolved over time. While the banking crisis and
its resolution has been a traumatic experience for the Icelandic economy
and society, with repercussions even for diplomatic relations between
Iceland and several European countries, it avoided a loss and thus
insolvency transfer from the banking sector to the sovereign. Iceland's
government has kept its investment rating throughout the crisis. And
while mistakes might have been made in the resolution process (Danielsson, 2011),
Iceland’s banking sector does not drag down Iceland’s growth any longer
and might eventually even make a positive contribution.
The resolution approach in Cyprus seems to follow the Icelandic
approach. While the Cypriot case might be a special one (as part of the
losses fall outside the Eurozone and Cypriot banks are less connected
with the rest of the Eurozone than previous crisis cases), there are
suggestions that future resolution cases might impose losses not just on
junior and maybe senior creditors of banks, but even on depositors to
thus reduce pressure on government’s balance sheets. A move towards
market discipline, for certain; whether this is due to learning from
experience, tighter government budgets across Europe or for political
reasons remains to be seen.
8. Banking union with just supervision does not work
The move towards a Single Supervisory Mechanism has been hailed as
major progress towards a banking union and stronger currency union. As
the case of Cyprus shows, this is certainly not enough. The holes in
the balance sheets of Cypriot banks became obvious in 2011 when Greek
sovereign debt was restructured, but given political circumstances, the
absence of a bank resolution framework in Cyprus and — most importantly —
the absence of resources to undertake such a restructuring, the
problems have not been addressed until now. Even once the ECB has
supervisory power over the Eurozone banking system, without a
Eurozone-wide resolution authority with the necessary powers and
resources, it will find itself forced to inject more and more liquidity
and keep the zombies alive, if national authorities are unwilling to
resolve a failing bank.
9. A banking union is needed for the Eurozone, but won't help for the current crisis!
While the Eurozone will not be sustainable as currency union without a
banking union, a banking union cannot help solve the current crisis.
First, building up the necessary structures for a Eurozone or European
regulatory and bank resolution framework cannot be done overnight, while
the crisis needs immediate attention. Second, the current discussion on
banking union is overshadowed by distributional discussions, as the
bank fragility is heavily concentrated in the peripheral countries, and
using a Eurozone-wide deposit insurance and supervision mechanism to
solve legacy problems is like introducing insurance after the insurance
case has occurred. The current crisis has to be solved before banking
union is in place. Ideally, this would be done through the establishment
of an asset management company or European Recapitalization Agency,
which would sort out fragile bank across Europe, and also be able to
take an equity stake in restructured banks to thus benefit from possible
upsides (Beck, Gros and Schoenmaker, 2012).
This would help disentangle government and bank ties, discussed above,
and might make for a more expedient and less politicized resolution
process than if done on the national level.
10. A currency union with capital controls?
The protracted resolution process of the Cypriot banking crisis has
increased the likelihood of a systemic bank run in Cyprus once the banks
open, though even if the current solution would have been arrived at in
the first attempt, little confidence in Cypriot banks might have been
left. As in other crises (Argentina and Iceland) that perspective has
led authorities to impose capital controls, an unprecedented step within
the Eurozone. Effectively, however, this implies that a Cypriot Euro is
not the same as a German or Dutch Euro, as they cannot be freely
exchanged via the banking system, thus a contradiction to the idea of a
common currency (Wolff, 2013).
However, these controls only formalize and legalize what has been
developing over the past few years: a rapidly disintegrating Eurozone
capital market. National supervisors increasingly focus on safeguarding
their home financial system, trying to keep capital and liquidity
within their home country (Gros, 2012). Anecdotal evidence suggests
that this does not only affect the inter-bank market but even
intra-group transaction between, let’s say, Italian parent banks and
their Austrian and German subsidiaries. Another example of the tragedy
of commons, discussed above.
11. Finally, there is no free lunch
This might sound like a broken disk, but the Global Financial Crisis
and subsequent Eurozone crisis has offered multiple incidences to remind
us that you cannot have the cake and eat it. This applies as much to
Dutch savers attracted by high interests in Icesave and then
disappointed by the failure of Iceland to assume the obligations of its
banks as to Cypriot banks piling up on Greek government bonds promising
high returns even in 2010 when it had become all but obvious that Greece
would require sovereign debt restructuring. On a broader level, the
idea that a joint currency only brings advantages for everyone involved,
but no additional responsibilities in term of reduced sovereignty and
burden-sharing and insurance arrangements also resembles the free lunch
idea.
On a positive note, the Cyprus bail-out has shown that Eurozone
authorities have learnt from previous failures by forcing an early
recognition of losses in Cyprus and by moving towards a banking union,
even if very slowly. As discussed above, however, there are still
considerable political constraints and barriers to overcome, so that it
is ultimately left to each observer to decide whether the glass is half
full or half empty.
References:
Acharya, Viral, Itamar Drechsler and Philipp Schnabl. 2012. A tale of two overhangs: the nexus of financial sector and sovereign credit risks. Vox 15 April 2012
Beck, Thorsten. 2012. Finance and growth: lessons from the literature and the recent crisis. Paper prepared for the LSE growth commission.
Beck, Thorsten, Hans Degryse and Christiane Kneer. 2012. Is more finance better?
Disentangling intermediation and size effects of financial systems. Journal of Financial Stability, forthcoming.
Beck, Thorsten, Daniel Gros, Dirk Schoenmaker (2012): Banking union instead of Eurobonds — disentangling sovereign and banking crises, Vox 24 June 2012.
Danielsson, Jon. 2011. How not to resolve a banking crisis: Learning from Iceland’s mistakes Vox, 26 November 2011
Gros. Daniel. 2012. The Single European Market in Banking in decline — ECB to the rescue? Vox , 16 Ocotber 2012
Levine, Ross. 2005. Finance and growth: theory and evidence. In Handbook of Economic
Growth, ed. Philippe Aghion and Steven N. Durlauf, 865–934. Amsterdam: Elsevier.
Wolff, Guntram. 2013. Capital controls are a grave risk to the eurozone. Financial Times 26 March 2013.
World Bank. 2001. Finance For Growth: Policy Choices in a Volatile World. Policy Research Report
Full article:
http://blogs.worldbank.org/allaboutfinance/cyprus-some-early-lessons
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